摘要：
目的 追踪观察几种幽门螺杆菌(Helicobacter pylori,H.pylori)根除疗法的疗效.方法 以初次治疗的H.pylori阳性患者为研究对象,其中包括长期服用非甾体抗炎药(nonsteroidal anti-inflammatory drugs,NSAID)的患者,分别给予标准三联疗法(阿莫西林+克拉霉素+埃索美拉唑,10 d)、含铋四联(阿莫西林+克拉霉素+埃索美拉唑+胶体果胶铋,10 d)、序贯疗法(阿莫西林+埃索美拉唑,5d,然后埃索美拉唑+克拉霉素+甲硝唑,5d)、伴同疗法(阿莫西林+克拉霉素+埃索美拉唑+甲硝唑,10 d).初治结束治疗28 d后,14C尿素呼气试验判断治疗效果,根治失败者距首次治疗56 d后开始补救治疗(阿莫西林+左氧氟沙星+埃索美拉唑+胶体果胶铋,14 d),并建议患者进行洁牙治疗,14C尿素呼气试验判断治疗效果,并随时记录治疗期间的不良反应.结果 标准三联疗法、含铋四联疗法、序贯疗法及伴同疗法的初治根治率分别为67.74％ 、77.91％、89.80％和88.46％,差异有统计学意义(P＜0.05),其中序贯疗法和伴同疗法的根治率显著高于标准三联疗法(P ＜0.05/6).服用NSAID的患者与普通患者之间使用三联疗法的根治率差异无统计学意义(69.44％vs 56.25％,P＞0.05).补救治疗根治率为87.10％,补救治疗前接受洁牙治疗者与未接受洁牙治疗者间根治率差异无统计学意义(90.48％ vs 85.37％,P＞0.05).四种初治疗法的不良反应率分别为14.52％、18.60％、4.08％和19.23％,组间差异无统计学意义(P＞0.05).服用NSAID的患者与普通患者之间使用三联疗法的不良反应率差异亦无统计学意义(12.50％vs 14.81％,P＞0.05).结论 序贯疗法及伴同疗法较标准三联疗法更易获得较高的根除率,服用NSAID药物与否并不影响标准三联治疗的根治率及不良反应率.含有阿莫西林、左氧氟沙星、埃索美拉唑和胶体果胶铋的14 d补救治疗可获得较好的疗效,而洁牙治疗并未提高补救治疗的根除率.%Objective To investigate several routine therapies for eradication of Helicobacter pylori (H.pylori).Methods H.pylori-positive patients were enrolled,including the chronic nonsteroidal anti-inflammatory drugs (NSAID) users.The patients were treated with standard triple therapy (Esomeprazole plus Amoxicillin and Clarithromycin,10 days),bismuth containing quadruplet therapy (Esomeprazole plus Colloidal bismuth pectin,Amoxicillin and Clarithromycin,10 days),sequential therapy (Esomeprazole plus Amoxicillin for 5 days,followed by Esomeprazole plus Clarithromycin and Metronidazole for 5 days),and accompany therapy (Esomeprazole plus Amoxicillin,Clarithromycin and Metronidazole,10 days).H.pylori eradication rate defined as one negative 14C-urea breath test ≥28 days posttreatment.Rescue therapy (Esomeprazole plus Amoxicillin,Levofloxacin and Colloidal bismuth pectin,14 days) were performed ≥56 days post the first treatment in the patients who failed the H.pylori eradication,and adverse events were assessed.Results H.pylori eradication rates of standard triple therapy,bismuth containing quadruplet therapy,sequential therapy and accompany therapy were 67.74％,77.91％,89.80％,88.46％,respectively.The eradication rate of sequential therapy and accompany therapy was higher than that in standard triple therapy (P ＜ 0.05/6).The eradication rates of non-chronic NSAID users and chronic NSAID users in standard triple therapy were 69.44％ and 56.25％ (P ＞ 0.05),the eradication rate of rescue therapy was 87.10％,and the eradication rates of patients who had received oral clean therapy was 90.48％,while 85.37％ of those who hadn't (P ＞ 0.05).The incidence rates of adverse events of standard triple therapy,bismuth containing quadruplet therapy,sequential therapy and accompany therapy were 14.52％,18.60％,4.08％,19.23％,respectively (P ＞0.05).The adverse events rates of non-chronic NSAID users and chronic NSAID users in standard triple therapy were 12.50％ and 14.81％ (P ＞ 0.05).Conclusion Sequential therapy and accompany therapy are more efficient than standard triple therapy.The eradication rate of chronic NSAID users has no diference compared with the normal patients.The rescue therapy including Esomeprazole,Colloidal bismuth pectin,Amoxicillin and Levofloxacin is efficient,but oral clean therapy can't enhance the eradication rate.
